Prior Authorization Specialist - Remote US (Any city, WI, US, 99999)

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

Gainwell Technologies is seeking a RemotePrior Authorization Specialist to process Medicaid Prior Authorization (PA) requests efficiently and accurately. This role involves reviewing and processing PA requests submitted via fax, portal, phone, or mail, ensuring compliance with Medicaid policies, and collaborating with clinical teams and state employees to meet strict deadlines. The ideal candidate is detail-oriented, can handle high-volume workloads with minimal errors, and provides excellent customer service to Medicaid providers.

Your role in our mission

As a Prior Authorization Specialist, you will:

• Process 500+ Prior Authorization requests per week while maintaining accuracy and compliance.
• Ensure PA requests align with Medicaid policies and procedures.
• Collaborate with the clinical team to ensure timely and accurate processing of PA requests.
• Communicate effectively with Medicaid providers regarding PA status and requirements.
• Work closely with Gainwell and State employees to facilitate smooth authorization processing.

What we're looking for

• Relevant experience in prior authorization processing, Medicaid policy, insurance, or pharmacy.
• Strong knowledge of Medicaid policies and prior authorization procedures (preferred).
• Excellent written and verbal communication skills with strong customer service abilities.
• Ability to multitask, manage time effectively, and meet strict deadlines in a remote setting.
• Proficiency in Microsoft Office and PC-based applications, with 50-60+ WPM typing speed preferred.

What you should expect in this role

• A fast-paced, deadline-driven environment where accuracy and efficiency are essential.
• Regular interaction with providers, clinical teams, and state employees.
• A role that requires strong attention to detail and problem-solving skills.
• Opportunities to enhance Medicaid knowledge and contribute to healthcare services.
• A supportive team environment focused on quality and compliance.

The pay range for this position is $30,500.00 - $43,500.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

Originally posted on Himalayas